The present state of the art knows a surgical suturing instrument disclosed in USSR Inventor's Certificate No. 571,948, which comprises a staple body with a jaw and a grip, a change magazine provided with staple slots and situated in the staple body, staple ejectors provided with stops and located in the magazine staple slots, a supporting body with a jaw provided with recesses for the staple to bend. The instrument has also a device for advancement of the staple ejector with a knife, and a mechanism for interlocking the staple and supporting bodies. This instrument is designed predominantly for stitching up organs through manipulating in a narrow and deep operative wound, and cannot be employed for establishing lateral gastrointestinal and intestinal anastomoses or, if anything, such an application of the instrument is to the utmost difficult to carry out, as according to the adopted application techniques, the instrument jaws can be introduced into the organs being sutured through the operative wound only when having been disjoined into the two halves. Since the staple and supporting bodies in the instrument under consideration are kinematically associated through the interlocking mechanism, they may not be disjoined during operation. In addition, with such a constructional arrangement of the instrument its overall length is so great that it offers much difficulties when manipulating the instrument in the operative wound to establish gastrointestinal and intestinal anastomoses.
These disadvantages have partially been obviated in the instrument disclosed in U.S. Pat. No. 3,079,608.
The instrument is known to comprise detachably hinged a supporting and a staple bodies, both having respective parallel-arranged jaws with recesses for staples to bend and for the staple magazine to fit, a staple ejector and a rack-type locking device to fix the bodies in position with respect to each other. However, this instrument also suffers from a number of disadvantages largely stemming from the fact that the instrument is practically devoid of adjusting the suturing gaps.
It is due to different wall thickness of the organs of the gastrointestinal tract in various patients that the range of suturing gaps required for the suturing instruments covers 2.3 mm, varying within 0.4 to 2.7 mm. With such wide variations of the wall thickness of the organs to be sutured the instruments having a constant suturing gap, fail to provide optimum forces of compression and suturing of the walls of the organs.
When suturing thick-walled organs with the instrument under discussion, the walls are unnecessarily injured, and the obtained sutures are oftentimes inadequately haemostatic.
Furthermore, the abovesaid constructional arrangement of the instrument fails to provide a possibility for increasing the suturing gaps, as this will affect very badly the quality of the suture for its length owing to a mutually unparallel travelling of the instruments jaws compressing the tissue being sutured.
The gap effective in between the surfaces of the instrument jaws that compress the tissue being sutured, is in fact shaped as a radial sector; that is why the distance between the compressing jaw surfaces is shorter at the base of the jaws than at their ends, and the difference in that distance becomes greater with an increase in the gap. All this leads not only to an inadequate compression of the tissues being sutured but also to a nonuniform height of the staple suture obtained, i.e., to the formation of a poor-quality suture.
It is an essential object of the present invention to provide a uniform compression of the suture through its length within a broad range of suturing gaps involved in establishing lateral gastrointestinal and intestinal anastomoses.
It is another object of the present invention to improve the quality and reliability of the suture obtained.
Among the other objects of the present invention there are worth noting a considerably diminished degree of injury to the organs being sutured, and an uneventful healing of the tissues operated upon during the postoperative period.
The abovesaid and other objects are accomplished due to the fact, that in a surgical instrument for staple suturing of organs, comprising detachably hinged a supporting and a staple bodies, both having respective parallel-arranged jaws with recesses for staples to bend and for the staple magazine to fit, as well as a staple ejector and a retainer to hold the bodies in position with respect to each other, according to the invention, the jaw of the supporting body has a slidable member capable of adjustably traversing towards the staple body and of being locked in a preset position, said slidable member having a number of recesses for staples to bend and incorporating a device to impart adjusting motion to the abovesaid slidable member.
Provision of a slidable member enables one to adjust the jaw-to-jaw gap so as to ensure a uniform compression of the suture throughout its length within a broad range of the suturing gaps. This, in turn, is conducive to higher quality and reliability of the suture obtained, greatly reduces the degree of injury to the organ tissues involved in surgery and provides for an uneventful healing of the tissues within the postoperative period.
In one of the embodiments of this invention a longitudinal slot is made in the bulk of the jaw to accommodate a bar adjustably slidable along the abovesaid slot.
In order to impart motion to the above bar, a crank-shaft is provided, the journals of which are made fast on the supporting body, and its throw is accommodated in a slot provided in the bar.
One of the crank-shaft journals is expedient to be provided with a lever having a lock to fix the crank-shaft in position after its turning.